Background WHO defined cerebral malaria (CM) in 1990 as a clinical syndrome of Plasmodium falciparum infection with unrousable coma not attributable to another cause. This has been broaden by adding altered consciousness, severe anemia, and respiratory distress without laboratory confirmation in order to curtail mrtality in children. This has resulted in overdiagnosis and overlooking other serious alternatives plus overburdening the scarce resources.

Aims To analyze the situation in Sudan by studying children admitted with clinical CM and do all the possible diagnostic work up in order to reach definitive diagnosis.

Patients and methods Patients belonged t the main hospitals in the capital Khartoum admitting to well organized emergency departments. Clinical and laboratory data were collected from children over 1 month of age admitted with clinical CM between April and November 2011. Patients were investigated for CM, acute bacterial meningitis (ABM) and Herpes encephalitis (HE).

Results One hundred and four children fulfilled the study criteria. CM was clinically diagnosed in 38 patients but only 5 were pure CM. Sixty three were suspected for ABM but 15 were confirmed cases. HE was defenitively diagnosed in only one case. There were 5 cases of mixed infection and the rest were unknown and presumed encephalitis due to viruses other than Herpes simplex.

Conclusion CM was clinically over-diagnosed in our study. It is advisable to do all the necessary investigations, particularly a thoruogh blood film examinatiom, beforediagnosing CM. It is recommended to study cases that resemble CM for more detailed viruses disease.